Hughston Clinic, P.C. Quick Reference Guide: Over-the Counter Medicine Over-the counter (OTC) medicines and products are reimbursable under a Health Care Flexible Spending Account (HCFSA) when the OTC product is used for medical purposes. Hughston Clinic allows the same expenses as those allowed by the IRS. Below is a description of the three IRS-defined categories, followed by product examples for each. Eligible OTC Medical Care Expenses Eligible items include medicines or products that alleviate or treat injuries or illness for you or your dependents. These drugs and products are not cosmetic in nature, or merely beneficial to your general health. Claims for OTC medicines and products must include an adequate receipt accompanied by the Flex Convenience Card request for documentation letter. An adequate receipt states the name of the medicine or product, the date, and the amount paid. You do not need to provide a statement from a medical provider or indicate a diagnosis in order to receive reimbursement. Dual-Purpose Products Certain OTC products are considered dual-purpose, such as vitamins and supplements. That’s because for some individuals, the product is used to alleviate a medical condition, while others use the product for general health and wellbeing. These products may be eligible for reimbursement, but require a Letter of Medical Necessity (LMN) stating your specific diagnosis or medical condition, a recommendation to take the specific OTC medicine to treat your condition, and documentation of the product and cost. If you have a condition that requires a specialized general purpose item (e.g., special laundry detergent due to allergies) and you have a letter of medical necessity, you can claim the difference between the specialized detergent and the regular detergent. You must submit a statement or printout showing how much a “comparable” non-medicated product costs. Excluded Items OTC products that are not medicines or that merely benefit your general health are NOT reimbursable , such as vitamins without a Letter of Medical Necessity (LMN). Reimbursements for OTC medicines still follow the existing rules regarding FSAs. The expense(s) must: Be incurred during your period of coverage Not be reimbursed through another plan Be substantiated by a detailed receipt Please note that stockpiling OTC medicines or items is not allowed and that requests for quantities deemed by Hughston Clinic to be stockpiling will be denied. Eligible OTC Expenses include medicines or products that alleviate or treat injuries or illness for you and your dependents. You do not need to provide a statement from a medical provider or indicate a diagnosis in order to receive reimbursement. Type/Class of Drug or Product Acne Treatment Allergy Prevention and Treatment Analgesics/Antipyretics Antacids and Acid Reducers Anti-arthritics Antibiotics (topical) Anticandial (yeast) Antidiarrheal and Laxatives Antifungal Antihistamines Anti-itch Lotions and Creams Asthma Medicines Cold Sore/Fever Blister Cold, Flu, Decongestant and Sinus Remedies Contact Lens Supplies Contraceptive / Family Planning Cough Suppressants or Expectorants Dehydration Dental/Denture Care Diaper Rash Ear Care Eye Care First Aid / Medical Supplies Foot Care Hemorrhoidal Preparations Home Diagnostic Tests and Kits Lactose Intolerance Menstrual Cycle Migraine Relief Motion Sickness NSAIDS Pediculicide Pre-natal Vitamins Skin Care Sleeping Aids Smoking Cessation Sunscreen Teething/Toothaches Topical Steroids Wart Removal Examples Acne Free • Acnomel • Ambi Even & Clear • Bye Bye Blemish • Clean & Clear • Clearasil • Murad Acne Complex Kit • Nature’s Cure Acne Treatment • Neutrogena Acne Treatment • OXY • Proactiv Solution • Stri-Dex • ZAPZYT Acne Treatment • Zeno Acne Cleaning Device ∗Generic and store brand equivalents of name brand acne treatments are also eligible Actifed • Allerest • Benadryl • Chlor-Trimetron • Claritin • Contac • Nasalcrom • Sudafed Aspirin • Advil • Alleve • Ibuprofen • Naprosyn • Tylenol • Midol • Pamprin • Premysyn PMS AXID AR • Gas-X • Maalox • Mylanta • Tums • Pepcid AC • OTC Prilosec • Tagamet HB • Zantac 75 Glucosamine • Chondroitin Bacitracin • Neosporin • Triple antibiotic ointment Femstat 3 • Gynelotrimin • Mycelex-7 • Monistat 3 • Vagistat-1 Ex-Lax • Immodium AD • Kaopectate • Pepto-Bismol Lamisil AT • Lotramin AF • Micatin Actidil • Actifed • Allerest • Benadryl • Claritin • Chlor-Trimetron • Contac •Drixoral • Sudafed • Tavist • Triaminic Bactine • Benadryl • Caldecort • Caladryl • Calamine • Cortaid • Hydrocortisone • Lanacort • Lamisil AT • Lotramin AF Bronitin Mist • Bronkaid • Bronkolixer • Primatene Abreva Cream • Herpecin Actidil • Actifed • Advil Cold and Sinus • Afrin • Alka Seltzer Cold and Flu • Afrinol • Alleve Cold and Sinus • Children’s Advil Cold • Contac • Dayquil • Dimetane • Dristan Long-Lasting • Drixoral • Neo-Synephrine 12Hour • Nyquil • Orrivin • Pediacare • Sudafed • Tavist-D • Thera-flu- Triaminic • Tylenol Cold and Flu • Cough Drops • Nasal Sprays • Throat Lozenges Cleaning and soaking solutions • Lens storage cases Ovulation predictor kits • Pregnancy tests • Spermicides • Condoms Robitussin • Vicks 44 • Chloraspetic • Mucinex • Cough Drops • Throat lozenges Pedialyte Orajel • Anbesol • Poligrip Aquaphor • Balmax • Desitin Ear drops Ear • Wax Removal Contact Lens supplies • Eye drops • Reading glasses • Eye patches Antiseptics • Witch Hazel • Peroxide • Bandages • First aid kits • Cold/hot packs for injury • Joint supports (ankle, elbow, knee, wrist) • Rubbing alcohol • Ace wraps • Splints • Thermometers • Liquid adhesives Arch and insole supports • Callous removers • Athlete’s Foot products (see anti-fungal) • Bunion, blister and corn treatments Preparation H • Hemorrhoid • Tronolane Blood pressure (monitor and related equipment) • Cholesterol • Diabetic equipment and supplies • Colorectal screenings • HIV test DairyCare • Dairy Relief • Lactaid • Lacteeze • Lactrase Midol • Pamprin • Premysyn PMS Advil Migraine • Motrin Migraine • Excedrin Dramamine • Marizine Advil • Aleve • Ibuprofen • Motrin • Naprosyn • Naproxen Nix • Rid Sunburn relief • Aloe Vera Commit • Nicoderm CQ • Nicorette • Nicotrol ∗Lotions or cosmetics that contain ingredients to protect you from the sun and/or list a SPF are not eligible Orajel • Anbesol Hydrocortisone Compound W • Dr. Scholl’s Clear Away • Wart-Off Dual-Purpose OTC Medicines and Products may be reimbursed under an FSA with a licensed health care provider’s LMN stating your specific diagnosis or medical condition, a recommendation to take the specific OTC medicine to treat your condition, and documentation of the product and cost. Type/Class of Drug or Product Calcium Dental fluoride Dietary Supplements Feminine Hygiene Fiber Supplements Healing Ointment Homeopathic Remedies Incontinence Joint Supplements Minerals Examples Calcium Carbonate ● Caltrate ● Tricalcium ● Phosphate ● Calcium Citrate ● Calcium Lactate ● Calcium Gluconate Reimbursable Use Diagnosis (e.g. osteoporosis) or at-risk for illness or injury based on physician note Protein bars ● Power drinks ● Ensure ● Glucerna ● Slimfast Documented specific medical condition Benefiber Metamucil Aquaphor ● Eucerin Chondroitin Calcium ● Caltrate ● Ferrous Sulfate ● Feosol ● Slow FE ● Folic Acid OTC Hormone Therapy Snoring Cessation Aids Vitamins Post-surgery or childbirth Documented specific medical condition; short duration Breathe Right ● Snorezz Weight Loss Excluded Use Routine use for general health Routine use for general oral care Sports performance, general energy and health Routine use for general health Routine use for dry or cracked skin Post-surgery Diagnosis of Arthritis Diagnosis (e.g. osteoporosis, anemia) or atrisk for illness or injury based on physician note Peri-menopausal or menopausal symptoms Sleep Apnea Vitamin B for treatment of scurvy Diagnosis of obesity or other documented specific medical condition Infants and toddlers Routine use for general health Routine use for general health Routine use for general health Routine use for general health Excluded OTC Products (non-eligible expenses) Type/Class of Drug or Product Cosmetic Products Dental Products Ear Care Herbal Supplements Toiletries Vitamins Examples Face soaps ● Creams ● Make-up- Perfumes ● Hair Removal Dental floss ● Toothpaste ● Toothbrushes ● Teeth whitening kits ● Mouthwash Ear Plugs Deodorant ● Shampoo ● Body sprays ● Soaps ● Moisturizers ● Chapstick Without a Letter of Medical Necessity